Fracture setting tool



Sept. 28, 1965 L. ABELSON FRACTURE SETTING TOOL 2 Sheets-Sheet 1 Filed March 14. v1962 zzfo Sept. 28, 1965 ABELsoN 3,208,450

FRAGTURE SETTING TOOL Filed March 14, 1962 2 Sheets-Sheet 2 j'/ Www@ ATTORNEYS 3,298,450 Patented Sept. 28, 1965 3,203,450 FRACTURE SETTING TOQL Louis Ahelson, 143 W. '73rd St., New York, NX. Filed Mar. 14, 1962, Ser. No. 179,739 12 Claims. (Cl. 12S-83) This invention relates to surgical instruments, and more particularly to fracture setting tools.

In the case of an upper arm break the usual procedure is to ream from the shoulder down, and to then insert a humeral pin from the shoulder. It is diflicult to locate the initial hole through the head of the humerus in proper alignment with the bone canal. Even after the reaming operation has been accomplished, it is sometimes diicult to properly insert the pin in alignment with the bone canal. Considerable use of X-rays must be made for success in the operation.

The general object of the present invention is to provide improved in struments or tools for the setting of a fractured bone, here illustrated as a fractured humerus. A more specic object is to provide a reamer designed to work in reverse direction, that is, from the broken end of the bone upward toward the shoulder. An ancillary object is to so design the tip of the reamer that it may be used to penetrate the bone at the head, and thus drill a hole which necessarily is in alignment with the reamed hole through the bone canal. Still another object is to so design the reamer and pin that the reamer then may itself be used to draw the pin downward into and through the reamed hole.

When the pin has been drawn as far as the fracture the reamer may be detached from the pin; the bone segments aligned; and the pin then driven the rest of the way into the lower segment until the head of the pin rests against the head of the bone. In accordance with a further feature and object of the invention the pin is itself improved by the provision of a sloping head which matches the slope of the bone at the tuberosity. The head preferably is provided with prongs to prevent rotation.

A further object of the invention is to provide an irnproved tool for driving the pin through the lower segment of the bone, and later for removal of the pin. For this purpose I provide an impactor-extractor with a slidable pile or hammer which may be used in either direction, that is, for insertion or removal, and which has a socket which mates with the head of the pin. In the form here illustrated the head is given a dovetail shaped cross section, and the socket of the hammer has a mating channel to receive the head, and additional means to close the ends of the channel in order to hold the head therein.

To accomplish the foregoing general objects, and other objects which will hereinafter appear, my invention resides in the fracture setting instruments and their relation one to another, as are hereinafter more particularly described in the following specification. The specification is accompanied by drawings in which:

FIG. l shows the reamer, the pin, and the impactorextractor, which are used in combination as later described;

FIG. 2 is a partially sectioned elevation showing the upward reaming operation;

FIG. 3 is a similar view showing how the reamer may be used to draw the pin downward through the upper segment of the bone;

FIG. 4 is a fragmentary section, drawn to enlarged scale, and explanatory of a detail;

FIG. 5 is a partially sectioned elevation showing how the impactor-extractor is employed for insertion or removal of the pin;

FIG. 6 is a fragmentary section drawn to enlarged scale to show the relation between the head of the pin and the socket; and

FIG. 7 shows the pin in final position in the bone.

Referring to the drawing, and more particularly to FIG. 1, the reamer 12 may be conventional in having longitudinal flutes and a handle 16. The tip may have cutting surfaces indicated at 14. The precise nature of the cutting surfaces, including also the flutes, is not critical, and these may be made in accordance with any of a number of different techniques. However, the present reamer differs importantly in having a screw threaded tip 20. This serves a purpose described later.

The pin 22 in this case is a humeral pin. The shank may be conventional, and it may be either round or provided with longitudinal flutes, in accordance with any one of several previously established practices. The lower end may have transverse serrations 24, if desired. These too are not new. What is new is that the lower end has an internal thread dimensioned to receive and mate with the screw 20 shown at the upper end of the reamer 12. This is better illustrated in FIG. 4, which shows how screw 2) is received in an internally threaded socket 26 formed inside the lower end of the pin 22.

Reverting to FIG. 1, pin 22 has a head 28 with spaced sharp prongs 30. By reference to FIGS. 5 and 6 it will be seen that the head 28 is disposed at an angle such as to mate with the angle of the subjacent part of the bone, called the tuberosity. Also the sides 22 are collateral but angularly disposed to give the head of the pin a dovetail shaped cross section.

Reverting to FIG. 1, the impactorextractor comprises a slide rod 34, a handle 35 at one end, a socket 3S at the other end, and a pile or hammer 40, which is slidable on the rod 34. It thus may be used as a hammer in either direction, it being struck against the top 42 of the socket when inserting the pin, and against the bottom 43 of the handle 36 when removing the pin at a later date.

Referring now to FIGS. 5 and 6, the socket 3S has a dovetail shaped channel which mates with the head 28 of the pin. The lower end of socket 3S and the channel are disposed at an angle which matches that of the head 23, so that the slide rod 34 (FIG. 5) is in alignment with the pin 22. The socket is also provided with means to hold the head in the channel, and in the present case this consists of a sleeve 44 frictionally slidable on the socket. The sleeve may be provided with a resilient tongue 46 slidable in a groove 48 to help hold the sleeve in desired position. In its down position, shown in FIG. 6, it closes 'the ends of the channel, thereby holding the head of the pin in the socket. In its upper position, shown in FIG. 5, the ends of the channel are cleared so that the tool may be applied or removed. If desired the spring tongue 46 (FIG. 6) may be received in recesses to help hold the sleeve in either raised or lowered position, but friction alone is adequate, as here shown.

Referring now to FIG. 2, the fractured bone illustrated is an upper arm bone or humerus. It is shown with two breaks, one at 52 and the other at 54, but for the present purpose the same description would apply ilf there were only a single break at the point 54. After making an incision in the flesh of the arm to expose the break at 54, the reamer 12 is inserted in the bone canal 56 and worked upward or drilled through the cellular bone and marrow. At this time it is preferably guided along that side of the bone which is toward the outside, that is, aligned with the tuberosity and away from the smooth round bearing part S8. It is then used as an auger or drill to penetrate the hard upper end of the bone. It is exposed by a suitable incision at the shoulder, the latter being easily located after seeing the bulge caused by the tip of the reamer as it comes through the bone. With normal bone configuration and position the reamer passes through the tuberosity and comes outside the scapula.

Referring now to FIG. 4, the lower end of pin 22, then is screwed 0n to the threaded end 20 of the reamer 12, and the reamer then is used to draw the pin 22 into the upper segment 60 of the bone. Thus the very act of removing the reamer serves also to properly guide and pull the pin through the reamed bone canal.

When the lower end of the pin reaches the fracture 54, the reamer 12 is removed from the pin by unscrewing the same. It will be understood that at this time only the lower part of the pin is in the bone, the remainder projecting well above the shoulder. The lower segment 62 of the bone is then aligned with the upper segment 60, and the remainder of the pin is driven into the bone canal of the lower segment 62. To aid this operation, the impactor-extractor is attached to the head, and the slidable pile of the impactor-extractor is used to drive the pin home. The sloping head of the pin, while obviously desirable, would introduce a disadvantage when using an ordinary hammer, in that it would make it dithcult to drive the pin straight. However, with the special sloping socket here shown the driving force is in true alignment with the pin despite the angular position of the head. The prongs 3) maintain the head in proper orientation. Flutes when used also help serve the same purpose.

The sleeve 44 of the socket may be raised, and the tool then removed, following which the incisions are closed.

At a later date, when the bone has knitted, the pin is removed. For this purpose a suitable incision is made at the shoulder to expose the head of the pin. The impactor-extractor is then applied to the head, and the pile 40 is used for upward thrust until the pin is withdrawn.

The description so far is applicable to a single break, as shown at 54. If there is another break, as shown at 52, the same tools and pin serve for both breaks. If the only break were that at 52, the above description would apply, except that the initial reaming operation would be upward from the break 52, instead of from the break 54.

One advantage of my improved instruments for the described purpose is that the diameter of the pin may be increased compared to the dimension previously used. I have already increased the diameter from five millimeters to seven millimeters, and I believe that further increases may be made. In previous practise this was not possible because a large margin for error was needed in the location of the pin relative to the bone canal. The newly increased pin diameter not only increases strength but helps insure better alignment of the bone segments.

The present improvement markedly reduces the operative time and the trauma previously attendant on treating this type of fracture. The previous uncertainty in finding the medullary canal, initially with the reamer, and subsequently with the pin, necessitated taking X-ray pictures. This subjected the personnel to repeated X-ray exposures, and inflicted much trauma on the tissues involved. The accuracy of this new technique obviates the necessity for taking X-rays, and minimizes trauma. Because of the minimal trauma to the patient, it is rarely necessary to resort to transfusions.

The pin here illustrated is a humeral pin, it being used in the humerus, but in the claims the pin is referred to more broadly as a bone aligning pin, because instruments like those shown, but with appropriate changes, may be used for other bones.

It is believed that the construction of my improved instruments or tools for fracture setting, and the method of using the same, as well as the advantages thereof, will be apparent from the foregoing detailed description. It will also be apparent that while I have shown and described the invention in a preferred form, changes may be made without departing from the scope of the invention, as sought to be dened in the following claims.

I claim:

l. A fracture setting tool comprising a reamer and a pin, the reamer being detachably joined to the pin, said reamer having an elongated slender reamer body with a handle at one end and a reamer tip with cutting edges at the other, said reamer tip including a fastening means smaller in diameter than the reamer body, and said pin having a head at one end and a socket at the other so mating with the fastening means of the reamer that the reamer tip may be worked through the bone canal from the broken end of a broken bone to and through the remote end and there receive the pin and then be drawn back in order to draw the pin into the bone from the remote end of the bone toward the broken end.

2. A fracture setting tool comprising a reamer and a pin, the reamer being detachably joined to the pin, said reamer having an elongated slender reamer body with a handle at one end and a reamer tip with cutting edges at the other, said reamer tip including a threaded screw smaller in diameter than the reamer body, and said pin having a head at one end and an internally threaded socket at the other end mating with the threaded screw of the reamer, whereby the reamer tip may be worked through the bone canal from the broken end of a broken bone to and through the remote end and there receive the pin and then be drawn back in order to draw the pin into the bone from the remote end of the bone toward the broken end.

3. A fracture setting tool comprising a reamer and a pin, the reamer being detachably joined to the pin, said reamer having an elongated slender reamer body with a handle at one end and a reamer tip with cutting edges at the other, said reamer tip including a threaded screw smaller in dia-meter than the reamer body, and said pin having a head at one end and an internally threaded socket at the other end mating with the threaded screw of the reamer, whereby the reamer tip may be worked through the bone canal from the broken end of a broken bone to and through the remote end and there receive the pin and then be drawn back in order to draw the pin into the bone from the remote end of the bone toward the broken end, the head of said pin being disposed at an angle.

4. A fracture vsetting tool comprising a reamer and a pin, the reamer being detachably joined to the pin, said reamer having a handle at one end and a reamer tip at the other, said reamer tip including a pointed threaded screw, and said pin being a bone alignment pin having a head at one end and an internally threaded socket at the other end mating with the threaded screw of the reamer, whereby the reamer tip may be worked from the broken end of a broken bone to and through the remote end and there receive the pin and then be drawn back in order to draw the pin into the bone from the remote end of the bone toward the broken end, the head of said pin being disposed at an angle, and having means to prevent rotation of the pin.

5. A bone aligning pin and an impactor-extractor for use with said pin, said impactor-extractor being detachably joined to said pin, said pin having a head at one end, said head having collateral angularly disposed sides giving the head a dovetail cross-section, said impactor-extractor comprising a slide rod, a handle at one end of the rod, a socket at the other end, and a pile slidable on said rod for use in either direction, said socket comprising a dovetail shaped channel dimensioned to receive the head of the pin, and said socket further including a longitudinally slidable sleeve which may be slid around the head to close the ends of the dovetail channel.

6. A bone aligning pin and an impactor-extractor for use with said pin, said impactor-extractor being detachably joined to said pin, said pin having a head at one end disposed at an angle, said head having collateral angularly disposed sides giving the head a dovetail cross-section,

said impactor-extractor comprising a slide rod, a handle at one end of the rod, a socket at the other end, and a pile slidable on said rod for use in either direction, said socket comprising a dovetail shaped channel dimensioned to receive the head of the pin, said channel being at an angle matching that of the head so that the slide rod and pin are in alignment, and said socket further including -a longitudinally slidable sleeve which may be slid around the head to close the dovetail channel.

7. A bone aligning pin and an impactor-extractor for use with said pin, said impactor-extractor being detachably joined to said pin, said pin having a head at one end disposed at an angle, .and having prongs to prevent rotation of the pin, said head having collateral angularly disposed sides giving the head a dovetail cross-section, said impactor-extractor comprising a slide rod, a handle at one end of the rod, a socket at the other end, and a pile slidable on said rod for use in either direction, said socket comprising -a dovetail shaped channel dimensioned -to receive the head of the pin, said channel being at an angle matching that of the head so that the slide rod and pin are in alignment, said socket further including a longitudinally slidable sleeve which may be slid around the head to close the dovetail channel, and resilient means to hold the sleeve in channel closing position.

8. An impactor-extractor and a bone aligning pin detachably attached thereto, said bone aligning pin having a head with a dovetail shaped cross section, said impactorextractor comprising a slide rod, a handle at one end of the rod, Ia socket -at the other end, and a pile slidable on said rod for use in either direction, said socket comprising a dovetail shaped channel dimensioned to receive the head of the pin with which it is intended to be used with the slide rod in alignment with the pin, and said socket further including a longitudinally slidable sleeve which may be slid around the head to close the ends of the dovetail channel.

9. An impactor-extractor and a bone aligning pin detachably attached thereto, said bone aligning pin having an -angularly disposed head with a dovetail lshaped cross section, said impactor-extractor Icompri-sing a slide rod, a handle at one end of the rod, a socket at the other end, and a pile slidable on said rod for use in either direction, said socket comprising a dovetail shaped slot dimensioned and disposed at a mating angle to receive the head of the pin with which it is intended to be used with the slide rod in alignment with the pin, said socket further including means to hold the head in the dovetail channel.

10. A relatively long slender intra-medullary humeral pin, said pin having an internally threaded socket at one end for temporarily receiving the matingly threaded tip of a reamer, and having a head at the other end, said head being disposed at an angle and having prongs to prevent rotation of the pin.

11. A fracture setting tool comprising a reamer and an impactor-extractor and a pin having a head, the reamer being detachably joined to the pin, and the impactorextractor being detac'hably joined to the head of the pin, said reamer having a handle at one end and `a reamer tip at the other, said reamer tip including a pointed threaded screw, said pin being` a bone alignment pin having the said head at one end and an internally threaded socket at the other end dimensioned to mate with the threaded Screw of the reamer, whereby the reamer tip may be worked from the broken end of a broken bone to and through the remote end and there receive the pin and then be drawn back in order to draw the pin into the bone from the remote end of the bone toward the broken end, the head of the pin having means to prevent rotation of the pin when fully inserted, said impactor-extractor comprising a slide rod, a handle at one end of the rod, a pile slidable on said rod for use in either direction, and means to detach-ably join the slide rod to the head of the pin for hammer action in either direction.

12. A relatively long slender intra-medullary bone aligning pin, said pin having an internally threaded socket at one end for temporarily receiving the m-atingly threaded tip of a reamer, and having a head at the other end, said head having collateral angularly disposed sides Whic'h converge in a direction toward the said socket, whereby said head has a dovetail shaped cross section to facilitate extraction of the pin, and said head having additional means to inhibit rotation of the pin when positioned in a bone.

References Cited bythe Examiner UNITED STATES PATENTS 63,822 4/67 Young T 145-114 134,091 12/72 Newell 14S-1,14 X 216,023 6/79 Crane 145-114 2,489,870 11/ 34 Dzus 12S-92.6

OTHER REFERENCES British Medical Journal, Jan. 6, 1934, p. 21, only relied upon.

The Journal of Bone and Joint Surgery, vol. 35B, October 1953, p. 44, relied upon. Advertisement of the Norman tibia bolt by De Puy.

Surgery, vol. 29, No. 6, June 1951, pp. 868 and 869, relied upon, FIG. 1, Wire identified by H.

Zimmer Catalogue, copyright 1954, p. 111, Fig. 401; p. 115, FIG. 460.

RICHARD A. GAUDET, Primary Examiner.

JORDAN FRANKLIN, Examiner. 

11. A FRACTURE SETTING TOOL COMPRISING A REAMERE AND AN IMPACTOR-EXTRACTOR AND A PIN HAVING A HEAD, THE REAMER BEING DETACHABLY JOINED TO THE PIN, AND THE IMPACTOREXTRACTOR BEING DETACHABLY JOINED TO THE HEAD OF THE PIN, SAID REAMER HAVING A HANDLE AT ONE END AND A REAMER TIP AT THE OTHER, SAID REAMER TIP INCLUDING A POINTED THREADED SCREW, SAID PIN BEING A BONE ALIGNMENT PIN HAVING THE SAID HEAD AT ONE END AND AN INTERNALLY THREADED SOCKET AT THE OTHER END DIMENSIONED TO MATE WITH THE THREADED SCREW OF THE REAMER, WHEREBY THE REAMER TIP MAY BE WORKED FROM THE BROKEN END OF A BROKEN BONE TO AND THROUGH THE REMOTE END AND THERE RECEIVE THE PIN AND THEN BE DRAWN BACK IN ORDER TO DRAW THE PIN INTO THE BONE FROM THE REMOTE END OF THE BONE TOWARD THE BROKEN END, THE HEAD OF THE PIN HAVING MEANS TO PREVENT ROTATION OF THE PIN WHEN FULLY INSERTED, SAID IMPACTOR-EXTRACTOR COMPRISING A SLIDE ROD, A HANDLE AT ONE END OF THE ROD, A PILE SLIDABLE ON SAID ROD FOR USE IN EITHER DIRECTION, AND MEANS TO DETACHABLY JOIN THE SLIDE ROD TO THE HEAD OF THE PIN FOR HAMMER ACTION IN EITHER DIRECTION. 